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LACERATION ( CUT )
A laceration (cut) is a wound anywhere on the body caused by a sharp or dull object. Depending on the sharpness of the object the edges may be jagged, dirty, or bleeding. Lacerations most often affect the skin, but any tissue may be lacerated, including subcutaneous fat, tendon, nerves, blood vessels, muscle, or bone.
When to repair?
A laceration should be repaired if any ONE of these apply: a) continues to bleed after application of pressure for ten to fifteen minutes b) is more than one-eighth to one-fourth inch deep or exposes fat, muscle, tendon, or bone c) causes a change in function surrounding the area of the laceration d) is dirty or has visible debris e) located in an area where an unsightly scar is undesirable or near vital structures: nose, mouth, eyes, ears, etc.
How soon do they need to be repaired
Lacerations are less likely to become infected if they are repaired soon after they occur. Many physicians will not repair a laceration that is more than eight hours old because the risk of infection is too great.
The procedure is similar to repairing a tear in clothing. Primary care physicians, emergency room physicians, and surgeons usually repair lacerations. The main goals are to stop bleeding, prevent infection, preserve function, and restore appearance.
Before repairing the laceration, the physician thoroughly examines the wound and the underlying tendons or nerves. If nerves or tendons have been injured, they may have to be repaired first. The laceration is cleaned by removing any foreign material or debris. Removing foreign objects from penetrating wounds can sometimes cause bleeding, so this type of wound must be cleaned very carefully. The wound is then irrigated with saline solution and a disinfectant. The disinfecting agent may be mild soap or a commercial preparation. An antibacterial agent may be applied.
Once the wound has been cleansed, the physician anesthetizes the area of the repair by injecting a local anesthetic. The surgeon may need to trim the jagged edges. To improve the healing process and future appearance severely damaged tissuesl must be removed. If the laceration is deep, several sutures are placed in the tissue under the skin to help bring the tissue layers together. Suturing also helps eliminate any pockets where tissue fluid or blood can accumulate. The skin is closed with sutures. Suture material used on the surface of a wound is usually non-absorbable to minimize the scarring. A light dressing or an adhesive bandage is applied for 24-48 hours. If the laceration is the result of a human or animal bite, if it is very dirty, or if the patient has a medical condition that alters wound healing, oral antibiotics may be prescribed. If tetanus immunization is not up to date, the tetanus shot may
What to do after the repair
The laceration is kept clean and dry for at least 24 hours after the repair. Light bathing is generally permitted after 24 hours if the wound is not soaked. Sutures are removed 3-14 days depending on complexity and location of the wound.
Usually we recommend to clean the area twice a day with a Hydrogen Peroxide readily available at your local drug store. You may use a Q tip to do that. Be extra careful around the eyes. We DO NOT routinely recommend the application of ointment, like Bacitracin or neomycin because up to 30% of kids may have an allergic reaction to the ointment.
One week after the sutures are removed we recommend applying a sunblock SPF 30 or higher to prevent scar discoloration. During the early healing period the scar will be pink. During this stage the scar is very vulnerable to sun. Sun exposure even during clowdy days will eventually result in permanent darkening of the scar (aka solar tattooing). To prevent that and to make sure that the scar is least noticable, please continue to apply sunblock until the scar matures (pink color goes away). The pink color may stay up to 6-12 month.
The repair should be observed twice a day for signs of infection, which include redness, swelling, tenderness, drainage from the wound, red streaks in the skin surrounding the repair, chills, or fever. If any of these occur, the physician should be contacted immediately.
Risks The most common complication of any laceration repair is infection. Risk of infection can be minimized by cleansing the wound thoroughly. Wounds from bites or dirty objects or wounds that have a large amount of dirt in them are most likely to become infected.
All lacerations will heal with a scar. Wounds that are repaired with sutures are less likely to develop scars that are unsightly, but no one can predict how wounds will heal and who will develop unsightly scars.
When to use a plastic surgeon
The main advantage is that the plastic surgeon us usually most aware of techniques and specialized suture materials available to minimize scarring. Meticulous use of Plastic surgery techniques can improve the appearance of many scars. If you would like to have a plastic surgeon repair the cut, please inform the emergency room doctor or call your plastic surgeon's office. Many private insurance companies will pay for plastic surgery specialist. Out of pocket costs depend upon the severity, location, size of the laceration and specific insurance policy.